How to Treat Shin Splints: a sports physio’s advice

What is a shin splint injury?

The anatomy of the painful area of the shin

A shin splint is an injury to the periosteum. The periosteum is a membrane that forms the most superficial layer of bone (in our case, the tibia, below the knee). This layer surrounds the shaft of the bone. Every bone has a periosteum, including the femur or the fibula. Muscles and tendons attach onto this bony structure. In the lower leg, these are mainly the tibialis anterior, the soleus, the posterior tibialis and the flexor hallucis longus.

Why does a shin splint hurt?

With a shin splint, the periosteum becomes inflamed. This inflammation is simply the consequence of the strain placed on the periosteum. Certain activities cause the muscles surrounding the bone to stretch, contract and compress, putting stress on the membrane of the bone. Repeated impacts are also demanding for the periosteum and the lower limbs. These repeated stresses place a strain on the bone that it can no longer withstand.[1] The main muscles involved are the tibialis anterior, the posterior tibialis and the FHL. The tissue then becomes painful to the touch, as well as during contraction or stretching. In rare cases, if the strain is excessive, this can go as far as an associated bone fracture (or stress fracture).[1]

Which sports contribute to shin splints?

Not every sporting activity causes shin splints. Repeated impacts on the lower limbs need to be taken into account, as well as the muscular strain on the legs. Running (jogging), skipping rope or jumping sports like volleyball are common sources of shin splints. The type of shoe, insole, and the strength of the foot or hip can also have an impact on the onset of this pain.[2]

If your pain is located more on the inner edge of the shin, with a possible associated tendon injury, read our dedicated guide on posterior tibial shin splints. If it’s located more on the outer edge, head to our guide on anterior tibial shin splints.

Treating shin splints in rehab with a sports physio

There are many treatments available, but they need to be chosen carefully to allow a quick return to sport without lasting effects.

The importance of the physio’s initial assessment interview

During the interview, the physiotherapist will try to understand which factors may have triggered this pain. The sport practised is the key element, but other lifestyle habits shouldn’t be overlooked. Occupation, lifestyle, other activities and the type of shoe worn are all important factors to take into account.

The clinical examination during the first consultation with the sports physio

The assessment aims to evaluate the different imbalances during the clinical examination. To do this, the physio will examine the forefoot and the arch of the foot (pronation or supination), the muscles of the lower leg, the mobility of the knee, kneecap and hip, and the strength of the thigh muscles (quadriceps and hamstrings). They will, of course, check for pain on palpation of the soleus, tibialis anterior or posterior tibialis, as well as on percussion of the tibia.

Which physiotherapy treatment is best suited to treating shin pain?

The treatment will depend on the assessment, but often includes mobility work for the joints of the foot, ankle and knee, and muscle strengthening of the anterior or posterior muscles depending on the imbalances found. Stretching may also be included. A gradual return to sport should also be set up, starting for example with swimming, then a gentle return to impact sports such as running.

The importance of the foot and the podiatrist in treating shin splints

The podiatrist is a valuable ally in treating shin splints. By analysing the arch of the foot, the toes, the ankle bones, the knee and the joint balance of the lower limbs, they can make you a set of insoles. This helps reduce the excessive strain on the tibia that makes the periosteum painful to the touch or when jogging. These insoles also allow for a quicker return to sport and running.

Other techniques to relieve shin splint pain

There are many techniques used to relieve shin splint pain. They have an anti-inflammatory effect and can act on the joints or on muscular tension. Massage, the use of heat or cold, green clay poultices or wintergreen oil are often used, but have limited scientific evidence behind them.

Is rest effective for relieving shin splints?

Rest should never be the main treatment for this type of injury. Even though it can reduce pain in the muscles or joints, this approach is only effective in the short term. For an effective long-term return to sport, muscle strengthening of the soleus, posterior tibialis and tibialis anterior should always be part of the treatment.[3]

When should you see a specialist for shin splints?

Specialists (rheumatologists, sports doctors) can be consulted as soon as the pain starts. They can then prescribe imaging to make a diagnosis. X-rays or MRI don’t seem to be relevant for diagnosing shin splints. Ultrasound (quick, non-invasive and inexpensive) or a bone scan are more effective. The doctor may also prescribe anti-inflammatories to make rehabilitation easier.

The HOPP care programmes to heal your shin splints and get back to sport

Healing from shin splints requires comprehensive support. HOPP offers you a wide range of exercises, with the option of guided online rehab, to get you back to your activities as quickly as possible. By combining stretching, mobility, strengthening and training load management, HOPP supports you all the way back to the field, for an optimal and confident return.

En bref

• Stretching the muscle chains of the lower leg
• Mobility of the foot, ankle and knee
• Strengthening the tibialis anterior, posterior tibialis and soleus
• Progressive training load management

The programme runs from 3 to 9 weeks depending on the injury and ends with a return-to-play phase that allows a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in analysing and caring for athletes. You’ll also find theoretical content throughout your progression, so you can master every aspect of your recovery by understanding your body’s responses and adapting your treatment independently. If you need it, our team of physiotherapists is there to listen and support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your leg is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

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